Dupilumab medicine was approved on the list of mandatory medicines by the ANS; drug benefits patients who were without treatment option
By Gabriela Cupani, from Agência Einstein – Health plans should offer dupilumab to adult patients with moderate or severe atopic dermatitis who were without a treatment option. The National Agency for Supplementary Health (ANS) approved the incorporation of the medicine in the list of mandatory coverage for those who have failed, contraindicated or are intolerant to the use of Ciclosporin, an immunosuppressant indicated in these cases.
Atopic dermatitis is a disease that leads to a chronic inflammatory process in the skin, causing reddish lesions that itch and flake off, usually affecting areas such as the knees, neck and elbows. Atopic eczema is quite common and, in Brazil, affects about 7% of adults, according to data from the Brazilian Society of Dermatology. Dupilumab has been used for some years and is indicated for critically ill patients who have failed other systemic treatments. It is the first drug that acts specifically on the inflammatory pathways related to the onset of the disease.
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“It inaugurated the era of specific immunotherapies for atopic dermatitis”, says Gleison Vieira Duarte, full member of the Brazilian Society of Dermatology and coordinator of the Atopic Dermatitis Campaign. “As it acts selectively, in addition to increasing the effectiveness of the treatment, it saves other pathways of the immune system and does not impact the user’s immunity, reducing possible adverse events”, he explains. Duarte points out, however, that it should only be indicated for those patients who have already undergone conventional treatments, such as older oral immunotherapies or phototherapy.
Although the exact cause of the disease is not known, it is known that it has a strong hereditary component and that it involves the malfunction of the immune system and other alterations. Atopic dermatitis is usually associated with other diseases, including bronchitis, asthma and rhinitis.
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Duarte explains that access to medication is still variable. “For SUS patients [Sistema Único da Saúde] we are waiting for the protocol to be published and, until then, only those with severe asthma have guaranteed access to the drug in the public sector,” says the expert. For health plan users, the drug is now available.
difficult treatment
In addition to inflammation, the skin’s barrier function is compromised, facilitating exposure to external aggressors. “We compare atopic skin to a sieve, or a wall without cement, whose bricks (cells) let various irritants permeate, such as sweat, fragrances, etc. while allowing the loss of water that keeps the skin hydrated”, explains the specialist.
Atopic dermatitis has no cure and medications help control some of its manifestations, such as itching. Therefore, it is very difficult to treat all aspects of the disease and the patient needs to maintain a hydration and care routine because, in some cases, the crises occur when in contact with dust, some cleaning products or clothing fabrics, stress, among others. other causes.
Learn how to prevent crises
- Identify the risk factors that trigger seizures
- Take very good care of skin hydration, applying moisturizers to prevent dryness
- Baths must be cold or lukewarm and cannot be long
- Use neutral soaps on the skin
- Avoid over-bathing in chlorinated pools
- Choose light clothes, preferably cotton and not synthetic fabrics, which reduce perspiration
- It is also necessary to develop mechanisms to control stress, especially in patients with a strong emotional trigger for crises.
- As soon as symptoms appear (itching and redness of the skin), seek medical attention
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